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     LETTER TO THE EDITOR

NEONATAL PERFORATED APPENDICITIS


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Authors:  Kanchan Kayastha

Institute: Department of Pediatric surgery, The Children's Hospital and the Institute of Child Health Lahore, Pakistan

Address for Correspondence: Dr Kanchan Kayastha, Department of Pediatric surgery, The Children's Hospital and the Institute of Child Health Lahore, Pakistan

          *Email: drkanchan1@hotmail.com

 


ISSN:2226-0439

Journal of Neonatal Surgery

Volume 1(1), Jan-Mar 2012


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Submitted On: 15-11-2011

Accepted On: 25-11-2011

 Published on: 01-01-2012

Local ID: jns-2012-1-16

J Neonat Surg 2012;1(1):10

© Kayastha K, 2012, EL-MED-Pub Publishers

Conflict of Interest: None declared

Source of Support: Nil

 


How to cite:

Kayastha K. Neonatal perforated appendicitis. J Neonat Surg 2012;1:10.

 


 

DEAR SIR

Appendicitis is the most common cause of acute sur­gical abdomen in children and adults but very rare in infants and neonates. Nonspecific clinical features and low index of suspicion make its diagnosis and man­agement challenging which may result in high chances of complications like perforation and peritonitis thus increasing the morbidity and mortality. Appendicular perforation leading to peritonitis is a life threatening condition in neonates [1-3]. We are presenting a case of neonatal appendicular perforation leading to peritonitis.

A 12-day-old male baby weighing 3kg was admitted to neonatal emergency with progressive abdominal dis­tension, fever, irritability, and reluctance to feed. Baby was well for 10 days when he developed the symp­toms. On examination the baby was febrile (101F), ta­chycardia (150/min), mild respiratory distress and ab­dominal distension with generalized tenderness. Patient was dehydrated and irritable. Immediate first line management was given. Complete blood picture re­vealed leococytosis. X ray abdomen showed pneumo­peritonium. Patient was stabilized and operated.

At laparotomy, marked amount of gas present in ab­dominal cavity. Bowel loops were adherent with in­flammatory flakes. On further exploration perforated appendix was found (Fig. 1). The base of the appendix was perforated causing peritonitis. There were no necrotic patches on the gut. Large gut was of normal caliber. Appendectomy was done and rectal biopsy was taken. Abdomen washed with warm saline and closed in lay­ers. The post operative recovery was uneventful. The biopsy report excluded hirschsprung’s disease where as appendix revealed acute inflammatory changes with lymphatic hyperplasia.



Figure 1: Perforated base of appendix


Acute appendicitis is a rare cause of acute abdomen in neonates and never considered in the differential diag­noses. The funnel shaped wide base of appendix, liquid diet and recumbent position of the neonates are less likely to cause acute appendicitis. It is extremely diffi­cult to make a diagnosis of acute appendicitis in neo­nates due to non specific signs and symptoms that usually result in perforation of the appendix. The ap­pendicular perforation can lead to pneumoperitonium as in the index case.

Perforation could be due to sole inflammation of ap­pendix or could be the end result of another disease processes such as hirschsprung’s disease, necrotizing enterocolitis, cystic fibrosis etc. A thin appendicular wall and indistensible cecum predisposes to appendi­cular perforation in neonatal appendicitis. The treat­ment of perforated appendicitis in neonates is appen­dectomy, however, where there is strong suspicion of hirschsprung’s disease on account of delayed passage of meconium or operative findings suggest it a colostomy may be performed with serial biopsies. In ab­sence of suspicion of hirschsprung’s disease simple ap­pendectomy with peritoneal lavage with warm saline is indicated; rectal biopsy may be added to exclude hirschsprung’s disease.



REFERENCES

  1. Khan RA, Memon P, Rao KLN. Beware of neonatal Appendicitis. J Indian Assoc Pediatr Surg 2010;15:67-9.

  2. Gupta V, Sharma SB. Neonatal Appendicitis with Perforation: A case report and Review of Literature. J Indian Assoc Pediatr Surg 2005; 10(3): 179-80.

  3. Mirza B. Perforated appendicitis presenting as small bowel obstruction in an infant. APSP J Case Rep 2011; 2:26.

 


This is an Open Access article distributed under the terms of the Creative Commons Attribution unported License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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